An integrated alcohol abuse and medical treatment model for patients with hepatitis
C.

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Abstract

BACKGROUND: Patients with chronic hepatitis C virus (HCV) infection have high rates
of alcohol consumption, which is associated with progression of fibrosis and lower
response rates to HCV treatment. AIMS: This prospective cohort study examined the
feasibility of a 24-week integrated alcohol and medical treatment to HCV-infected
patients. METHODS: Patients were recruited from a hepatology clinic if they had an
Alcohol Use Disorders Identification Test score >4 for women and >8 for men, suggesting
hazardous alcohol consumption. The integrated model included patients receiving medical
care and alcohol treatment within the same clinic. Alcohol treatment consisted of
6 months of group and individual therapy from an addictions specialist and consultation
from a study team psychiatrist as needed. RESULTS: Sixty patients were initially enrolled,
and 53 patients participated in treatment. The primary endpoint was the Addiction
Severity Index (ASI) alcohol composite scores, which significantly decreased by 0.105
(41.7% reduction) between 0 and 3 months (P < 0.01) and by 0.128 (50.6% reduction)
between 0 and 6 months (P < 0.01) after adjusting for covariates. Alcohol abstinence
was reported by 40% of patients at 3 months and 44% at 6 months. Patients who did
not become alcohol abstinent had reductions in their ASI alcohol composite scores
from 0.298 at baseline to 0.219 (26.8% reduction) at 6 months (P = 0.08). CONCLUSION:
This study demonstrated that an integrated model of alcohol treatment and medical
care could be successfully implemented in a hepatology clinic with significant favorable
impact on alcohol use and abstinence among patients with chronic HCV.

Dr. Susanna Naggie completed her medical education at Johns Hopkins School of Medicine
and her internal medicine training at Duke University Medical Center (DUMC), where
she also served as a Chief Resident in Internal Medicine. She completed her Infectious
Diseases (ID) fellowship training at Duke and then joined the faculty in the Division
of ID. She is an Associate Professor of Medicine with Tenure and currently holds joint
appointments at the Duke Clinical Research Institute (DCRI, D